<h1 style="padding:20px 10px 5px 15px;font-size:16px;text-align:center;">Read me before Payment</h1>
<div style="padding:10px 45px 0px 45px;color:green;font-weight:bold;line-height:18px;">1. The below address should be the same as the one that you used for credit card application(it can be different from your shipping address). Otherwise it might cause payment failure.</div>
<div style="padding:10px 45px 0px 45px;">2. To ensure smooth transaction, please complete the payment within 48 hours. Otherwise, you will need to make a new order. </div>
<div style="padding:10px 45px 0px 45px;line-height:18px;">3. You are using the FashionPay visa payment method. It is verified by Trustwave and it is secured by Norton which can protect your credit card and other confidential information.</div>
<div style="padding:10px 45px 0px 45px;">4. Any problems about payment? Please let us know. You can post on our <a style="text-decoration:underline;" target="_blank" href="http://www.facebook.com/newjerseysoccer.Soccer.Jersey">Facebook</a>, or <a style="text-decoration:underline;" target="_blank" href="http://chat.5251.net/client.jsp?flag=1&companyId=8522&style=18846&locate=en">live chat</a> with our customer service.</div>
<link rel="stylesheet" type="text/css" href="<?=MY_URL?>/html/styles/shop/shop_buy.css" media="screen" />
<style>

	.moneyTable td{

		padding:10px;

	}

</style>
<br/><br/>
<?php 
	$us = array(
				"AL"=>"Alabama",
				"AK"=>"Alaska",
				"AS"=>"American Samoa",
				"AZ"=>"Arizona",
				"AR"=>"Arkansas",
				"CA"=>"California",
				"CO"=>"Colorado",
				"CT"=>"Connecticut",
				"DE"=>"Delaware",
				"DC"=>"District of Columbia",
				"FL"=>"Florida",
				"GA"=>"Georgia",
				"GU"=>"Guam",
				"HI"=>"Hawaii",
				"ID"=>"Idaho",
				"IL"=>"Illinois",
				"IN"=>"Indiana",
				"IA"=>"Iowa",
				"KS"=>"Kansas",
				"KY"=>"Kentucky",
				"LA"=>"Louisiana",
				"ME"=>"Maine",
				"MD"=>"Maryland",
				"MA"=>"Massachusetts",
				"MI"=>"Michigan",
				"MN"=>"Minnesota",
				"MS"=>"Mississippi",
				"MO"=>"Missouri",
				"MT"=>"Montana",
				"NE"=>"Nebraska",
				"NV"=>"Nevada",
				"NH"=>"New Hampshire",
				"NJ"=>"New Jersey",
				"NM"=>"New Mexico",
				"NY"=>"New York",
				"NC"=>"North Carolina",
				"ND"=>"North Dakota",
				"MP"=>"Northern Mariana Islands",
				"OH"=>"Ohio",
				"OK"=>"Oklahoma",
				"OR"=>"Oregon",
				"PA"=>"Pennsylvania",
				"PR"=>"Puerto Rico",
				"RI"=>"Rhode Island",
				"SC"=>"South Carolina",
				"SD"=>"South Dakota",
				"TN"=>"Tennessee",
				"TX"=>"Texas",
				"UM"=>"United States Minor Outlying Islands",
				"UT"=>"Utah",
				"VT"=>"Vermont",
				"VI"=>"Virgin Islands, U.S.",
				"VA"=>"Virginia",
				"WA"=>"Washington",
				"WV"=>"West Virginia",
				"WI"=>"Wisconsin",
				"WY"=>"Wyoming"
				);	
?>
<div align="center">
<form action="https://ewallet.altercards.com/index.php/Gatewayck2/securepay" method="post">
<table class="moneyTable" border="1" cellpadding="0" cellspacing="0" bordercolor="#c8d9e9" width="600">
	<tr>
		<td align="center" colspan="2"><img src="/images/echeck.gif" /></td>
	</tr>
	<tr>
		<td align="right">Amounts</td><td>$<?=$this->Amount?></td>
	</tr>
	<tr>
		 <td align="right">First Name:</td>
		 <td align="left"><input name="firstname" type="text" value="<?php echo $this->firstname;?>"/> 
		 <input name="merchantid" type="hidden" value="<?php echo $this->merchantid;?>"/>
			<input name="siteid" type="hidden" value="<?php echo $this->siteid;?>"/>
			<input name="order_id" type="hidden" value="<?php echo $this->order_id;?>"/>
			<input name="phone" type="hidden" value="<?php echo $this->phone;?>"/>
			<input name="email" type="hidden" value="<?php echo $this->email;?>"/>
			<input name="Amount" type="hidden" value="<?php echo $this->Amount;?>"/>
			<input name="currency_code" type="hidden" value="USD"/>
			<input name="md5_info" type="hidden" value="<?php echo $this->md5_info ?>"/>
			<input type="hidden" name="flag" value="1" />
		 </td>
    </tr>
    <tr>
		 <td align="right">Last Name:</td>
		 <td align="left"><input name="lastname" type="text" value="<?php echo $this->lastname;?>"/></td>
    </tr>
   
    <tr>
		 <td align="right">Country:</td>
		 <td align="left"><select name="country"><option value="US">US</option></select></td>
    </tr>
     <tr>
		 <td align="right">State:</td>
		 <td align="left"><select name="state" id="state">
		 	<?php foreach ($us as $k=>$v):?>
		 	<option value="<?php echo $k;?>"><?php echo $v;?></option>
		 	<?php endforeach;?>
		 </select></td>
    </tr>
    <tr>
		 <td align="right">Address:</td>
		 <td align="left"><input name="address" type="text" value="<?php echo $this->address;?>"/></td>
    </tr>
    <tr>
		 <td align="right">City:</td>
		 <td align="left"><input name="city" type="text" value="<?php echo $this->city;?>"/></td>
    </tr>
    <tr>
		 <td align="right">Post Code:</td>
		 <td align="left"><input name="postcode" type="text" value="<?php echo $this->postcode;?>"/></td>
    </tr>
    <tr>
		 <td align="right">*Routing Number:</td>
		 <td align="left"><input type="text" name="routing_number" value="" /></td>
    </tr>
    <tr>
		 <td align="right">*Account Number:</td>
		 <td align="left"><input type="text" name="account_number" value="" /></td>
    </tr>
    <tr>
		 <td align="right">*Drivers License:</td>
		 <td align="left"><input type="text" name="drivers_license" value="" /></td>
    </tr>
    <tr>
		 <td align="right">*Drivers State:</td>
		 <td align="left"><select name="drivers_state" value="">
		 	<?php foreach ($us as $k=>$v):?>
		 	<option value="<?php echo $k;?>"><?php echo $v;?></option>
		 	<?php endforeach;?>
		 </select></td>
    </tr>
     <tr>
		 <td align="right"></td>
		 <td align="left"><input type="submit" value="submit" onclick="return check()"/></td>
    </tr>
</table>
</div>
</form>

<div style="margin-top:10px;">
	<iframe id="paymentFrame" name="paymentFrame" frameborder="0" scrolling="no" height="1000px" width="1000px" ></iframe>
</div>
<script>
	function check()
	{
		if ($("input[name='routing_number']").val() == '') {
			alert('Please input Routing Number');
			return false;
		}
		if ($("input[name='account_number']").val() == '') {
			alert('Please input Account Number');
			return false;
		}
		if ($("input[name='drivers_license']").val() == '') {
			alert('Please input Drivers License');
			return false;
		}
		if ($("input[name='drivers_state']").val() == '') {
			alert('Please input Drivers State');
			return false;
		}
		return true;
	}
</script>